My thoughts on Waiting for the app-ocalypse: Will toughening FDA regulations disconnect the medical smartphone app industry?

I recently read Waiting for the app-ocalypse: Will toughening FDA regulations disconnect the medical smartphone app industry? [July 22, 2010 by Brendon Nafziger, DOTmed] and found it an informative read.  I'd like to add a few of my own thoughts.

The way this space is evolving is very interesting to me.  Whether you are in the industry or not, it should be to you as well.  Mobile engagement is the future.  Regarding the use of mobile devices in healthcare, while I can understand the FDA’s concern about medical devices and being sure that they follow the correct path to approval, I have to be concerned about the effects to both the industry and the patient (aka consumer) about the potential for overreaching by the FDA regarding what is or is not under their purview.  These comments do not even take into account the potential for the FCC to be involved as well since we are talking about mobile (ie wireless) devices.  Apple may play a role too, but that conversation is for another blog entry.

The future of successful medicine will rely on patients and caregivers being more engaged in their own therapy.  That is not rhetorical, it is fact.  For this to happen, the future is going to rely on mobile computing.

For this to work, from an informational standpoint (messaging, data capture, tracking, reporting), there will be little to no compliance if a patient has to carry around a bag of devices.  Many of these ‘tools’ are going to have to be in the form of software (web or application based) accessible from as few devices as necessary to tote around.   Think about today’s diabetic teenager carrying around a glucose meter, a pump and their cell phone.  Some companies have taken the step to integrate (or facilitate communication between) the meter and the pump and in fact, connect them as one and consolidate reporting from the device(s); a great step forward.  But here is the key compliance question:  When a device on his or her body buzzes or chimes, what do you think he reaches for first? That’s right, the cell phone.  What’s the logical next step to successful engagement with this patient?  Three devices with disparate function and reporting turned into two devices with consolidated function and reporting becoming one device with near time reporting employing the Smartphone for communication and analysis acting as one.

As you can see from my example, Smartphones should offer a solution for better management of healthcare costs for chronic conditions.  The way to manage the costs of caring for these patients is to enable them to self-manage their health. For that to happen, it must be reasonable and easy and fit the right tool (aka device used) to the patient.  By example

• Smartphones make it easy for patients to track important health information
• Smartphones make the technology convenient
• They are mobile; patients can use them at any time or any place.
• If apps are written to support it, they can alert and/or capture data even if no network infrastructure is in place.
• When connectivity is restored, Smartphones make it seamless for patients to share health information with their providers, caregivers and others within their care network.
• Finally, Smartphones used by the individual are selected by the individual.  That is the first step of engagement – a self-selected fit to their personality if you will.

Also, because there are so many mobile phones, Smartphones, etc. out there, it makes sense to extend into this diverse installed base for the benefit of the patient.  Forcing patients to change their provider or equipment is not cost effective or realistic, a fact that has already shown itself in the corporate environment where personal use of Smartphones has driven Enterprise to find ways to accommodate their employee’s facility for increased productivity for the same reasons it will in the case of patient care.  While adapting the technology is feasible for patients, providers, labs and hospitals – the potential costs to develop and go for approval on all of the platforms for the many potential uses of the empowered patient may have the downside of limiting the community of possible developers to the biggest companies with the biggest budgets.  These choices we make regarding regulation and process may, in effect, sideline the creative ideas of startups and small companies.  How realistic is it to test every version of each device in use with every potential device?  I think we have figured at least some of this out with diabetes as an example, each meter is not tested with every computer running every operating system; just the platforms themselves to be sure connectivity worked.  We need to consider this as we decide where the FDA and FCC belong when considering the evolution of mobile and its use in the space.

I think who the user is is another issue we have to consider as well and will go into this further in a later blog.

A few related links:

Smartphone apps make healthcare splash

The Future of Connected Health, Chapter 1

Participatory Health: Online and Mobile Tools Help Chronically Ill Manage Their Care

How Smartphones Are Changing Health Care for Consumers and Providers

http://www.chcf.org/publications/2009/09/participatory-health-online-and-mobile-tools-help-chronically-ill-manage-their-care

Health industry wants 'clarity' on m-health regulation (recently tweeted)

FDA, FCC discuss medical smartphone apps as industry adjusts to regulatory culture

Wireless-Life Sciences Alliance meeting highlights fast-evolving field

And a final note:

As I was reading various articles in preparing my thoughts on this, I came across something that tells me that mobile in healthcare is on the right track.  It’s from Stanford’s Dr. BJ Fogg: To change behaviors we need to “Put hot triggers in the path of motivated people.”

-hb

For want of Control, Apple Keeps Innovation Out Of App Store

Apple's desire for over-control of the platform blocks innovative apps that can otherwise only be picked up and installed on Jailbroken phones through the alternate stores like Cydia and Rock (recently announced merged). The latest example; FolderEnhancer (app on it's way) will add new features to iPhone folders  - iphonehacks.com/2010/09/folder.  Be sure to watch the video.  As with many other apps that have improved the user experience for those of us with Jailbroken phones, there is no logic to keeping apps like these out of the App Store for everyone to take advantage of. 

-hb

interesting iPad usage stats, consistent with my own experience

There are some interesting stats in the attached article on iPad use - not very promising as the future of mobile computing.  My own experience is consistent with use as a media device and for reading the paper and magazines.

I watch movies and TV shows when I am on a train or plane, on the treadmill, working out, etc.  This is probably my number one use for the device.  The iPad is clearly a better iPod than the iPod.

I also use if for some web browsing but this is difficult since sites with flash are a problem.  Apple's claim that they provide access to the whole internet is not remotely true.  Too many sites use flash, not just for video, but for menus, etc.  It is far too frustrating an experience to get hung up by this missing functionality.

I use the WSJ app a few times a week, when it is not as easy to read the actual paper.  I love the quality of this app.  I also love that they integrated the iPad app with the website so that articles saved on either go into the shared folders you have in your online account.

Magazines are also very readable on this device, more so then on the Kindle.  This is because you can scale the pdf's on the iPad and can not on the Kindle, color is also a key differentiator here.  The problem here is that unlike the functionality of cycling TV shows to and from the device as you finish them, many of the readers do not have this functionality so this is less then a smooth experience to manage.  Of the various apps for magazine, I like Good Reader the most.

I find book reading to be cumbersome on the iPad, reading on the Kindle is a far better experience.  The iPad weighs twice as much and the glare of the screen bothers my eyes over time.  Since I tend to sit down and read for a few hours at a time, this is a real issue.  It is also unreadable in the sun which is not an issue for the Kindle.

Here is the article with the stats:

http://www.mobiadnews.com/?p=4850

Here is a link to the Amazon Kindle Ad:

http://www.youtube.com/v/HGmRKSds9OY&color1=0xb1b1b1&color2=0xd0d0d0&hl=en_US&feature=player_embedded&fs=1

-hb

Good place to start would be an intro to Android

I figured a good start would be some background for people that know little or nothing about the Android phones at this point.  There seem to be lots of guy oriented commercials (with a techno angle) from either the manufacturer of a particular model or the carrier but not a lot of specifics other than there is a world of apps ie: the rotating globe of the market place.

Yahoo News' Gadget Hound did a pretty good job on the Android basics at the link below. So instead of reinventing, I will provide a link to their fine work on the basics.  My goal was to highlight usability and differences based on what I encounter in my use of the Apple 3GS and 4 (on the iPhone side) and htc Incredible (on the Android side).  Perhaps I'll even touch on a few iPad items as well.  That said, when there are other resources or tidbits I catch in my daily reading and browsing I'll post links as well.

Bullets 4 and 5 do a pretty good job on the Why or Why Not for an Android phone vs iPhone and I will go into more specifics on this over my next couple of posts.

Yahoo News - The Gadget Hound For Android newbies: 10 questions, answered

In an age of buy buy buy, is there a future in reuse, recycle for that which is otherwise lost?

In last Sunday's NY Times Magazine (didn't get to this week's yet), the back page article brought back some memories for me, both good and sad. The good were in line with the dispose, find it, take it and reuse it thoughts of the author. What our parents "recycled' from someone else when we were kids, be it from curbside, an old style flea market, the dump - one person's garbage or even just what didn't work for them anymore, could fill a need for another and/or even become a treasure (perhaps with a little work). When we were teenagers and young adults going out on our own, every possible "gift" was well appreciated whether it fit in with the decor or not and many items, especially in the furniture category made it's rounds, many times even among friends. There was a nostalgic feeling each time you visited a friend and sat on your old couch to watch tv way past the time it was useful or the center piece of perhaps your own apartment or house, living room, tv room, etc. I still miss a particular recliner and especially one glide rocking chair that were my favorites, perhaps currently somewhere at my sister's house or beyond.

A Discarded Chair Finds Its Way Home Again

Intro - iPhone 4 v htc Incredible

Ok, so it has been about a month since I upgraded my 3GS to an iPhone 4 and a little less than that for my entrée into the Android world with the htc Incredible. This blog is not intended to bash one platform or the another or even one phone or the other or for me to actually pick a winner. As a company executive with experience in small, US public and global public companies with a software developer background,, my goal is more to note and perhaps explore the differences from a slightly different angle than just a cell phone or smart phone user without similar experience would otherwise. My hope is that this will inform others and create and engaging dialog that will either lead to improvements or further evolution of the platforms whether from the platform developers themselves or independent developers looking to make a living, perhaps one app, a million users at a time. With the opening up of the cell phone as a development platform it is an exciting time for both cell phone users and developers alike. This is a new frontier for innovation with only the smallest possible capabilities yet explored. It is an exciting time in mobile computing with so much at stake for all the players as they fight it out for market share and platform presence. Blackberry, Microsoft, Apple iOS, Google Android, Perhaps even Snac will help us to utilize and evolve threes tools in ways previously never envisioned and even today not entirely foreseen. Let's see where this takes us.

Harvey

I already know what I know, so I am not interested in what you think and have to say ...

Tom Siegfried had a great comment in the July 31st Science News (in the magazine, but the site for them is (www,sciencenews.org). I love this magazine and have been a reader for a long time. I love that it's today topical and cover's what's out there as well as doing their own stories. It comes in a short format magazine, but in depth reporting and stories with links to background and more info on their site should you want to explore more on the various topics they report and write about. Anyway, in his editorial he said that "science is not the sum of past research as recorded in textbooks, but the active process of continuing to question nature even if those books say the answers are already in." He was by example talking about recent research finding that the proton may be not as big as has been thought in well-established scientific theories. and it's potential effects on what we currently believe. This was a timely read for me because this exact topic came up while visiting a friend of mine in the hospital last week. We were talking about scientist's lack of interest in ideas that buck the norm (or as Tom put it, what's "in the textbooks"). Bruce recently asked whether we were living in a computer simulation in his book "Reality is Virtual". His goal was to get the discussion going on the science behind his explorations into this idea. It is not like there isn't anyone asking, thinking about or discussing this topic since a search on Google will return numerous sites and dialog on this (although interestingly, not Bruce's). But at a quick glance, nothing mainstream science. It seems to me that we need to keep our minds open and challenge what is 'known' because it may not be what we think. There are other examples of this Bruce and I discussed, in 1915 when Alfred Wegener proposed his theory of Continental Drift (plate tectonics 'proved' in the 1960's), and more recently (1982 but recognized in 2005 with a Noble Price) Dr. Barry Marshall's discovery that ulcers can be caused by H. pylori. and the painful way he went about to to prove it when no one would listen.